More on the FDA ecig workshop

Those of you who watched my contribution to the workshop (which you can do by following the link in yesterday’s post) probably found the most memorable observation to be the one about San Francisco. But I am rather prouder of not missing a beat regarding a later question. Leading into that, there was a rambling multi-part question to the panel, which a couple of others responded to bits of. I took the mic last to respond to the phrase “renormalizing smoking” in the question.

I pointed out that this was a silly trope: How could ostentatiously not smoking — sending the signal “I used to smoke but I now think it is a bad idea so I vape instead” — possibly encourage smoking? The moderator, CTP’s Carolyn Dressler, responded that the questioner really meant “renormalize inhaling nicotine”, which I serious doubt is actually true but I ran with it anyway. (I am never quite sure about her, whether she is probing to motivate further scientific discussion, or whether she thinks she can play gotcha games to score debating points for her personal beliefs or CTP policy. I have never noticed her pushing follow-ups on CTP’s pet junk science pseudo-researchers to explain the basis for their unsupported claims.)

So I responded that using low risk tobacco/nicotine products is going to be the new normal, with about half the population doing it, like coffee today and (unfortunately) smoking 50 years ago. I believe I also used the phrase “what’s wrong with that?” After that, someone rushed another question up to her (that someone can handwrite on an index card so fast is impressive) and Dressler moved it to the top of the queue (reprise above parenthetical). It asked why I would want half the population to be addicted to nicotine. I believe it took me only a small fraction of a second to reply that it is not about what we want, but about what people want for themselves.

That is what I am most proud of.

I think it can be a really useful shock to the system for these people to remind them that they are in the business of trying to make the people act contrary to the people’s preferences. It is so embedded in the DNA of public health to not care about people’s preferences that they can get away without thinking about this fact or admitting it to themselves. Putting it in their faces is always good.

I then went on to dispute the trope about “addiction”. I pointed out that by the only official government definition of addiction that I am aware of, from NIDA, smoking does not qualify as addictive. But even if we quasi-define that slippery word to mean “that which is experienced by smokers”, there is no evidence that users of low-risk alternatives experience the same thing, and pretty compelling evidence that they typically do not. I have covered all that thoroughly before, so I don’t have to explain it to my readers. I think I probably should have pushed the point a bit further — for those in the audience who do not read or think — and pose my challenge for anyone to come up with a definition of “addiction” that includes smoking (let along vaping), but that excludes (and not by gerrymandering) eating or wanting to spend time with your kids and that constitutes a seriously bad thing.

Another major response I gave was to a question about how to better communicate the risks to the public. I responded “what risks?” and pointed out that the “perceptions and propaganda” research that had been presented on the previous day clearly showed that people seem to grossly overestimate the risk, and so it must be we should educate them about how low the risks are. I kind of regret not going on to say “I suspect the questioner meant to say ‘how can we better trick people into believing the risks are much higher than they are, in order to manipulate them into not vaping in cases where they might rationally choose to do so if they knew the truth?'”

My other regret is not getting to point out that about half the claims by UCSF liar Lauren Dutra, in her presentation on the first day, had been completely debunked in careful analysis following previous occasions that she or Glantz made the same claims, but that she just keeps repeating them anyway. This is the standard practice of tobacco controllers, and anyone who is actually seeking the truth needs to attend to the debunkings rather than listen to the liars. There was just no opening to say that.

And perhaps I had already thoroughly fried them enough for one day. It is probably already the case that they will look for any excuse not allow consumers to be represented again. Of course they are already doing that and I just barely snuck in as the first such representative ever, so this is not really a change. It is pretty clear that they are not going to do it unless some external pressure is applied.

The link to the 2nd day afternoon video appears in the previous post, as noted. The three others half-day videos are apparently also available, though I have not looked for them. I would guess if you follow the links from the start of the live blogs you get to the recordings of each morning session. Scroll through the comments first to someone’s link to the afternoon session for the first day.

Or someone who has opened the links could help me out and post the specific links.

As I reflect on the contents of all three workshops, the presenters, the information, and the questions posed by FDA to guide these exercises, I note that the direct or inferred answers to their questions do not bode well for the future of tobacco harm reduction in general or electronic cigarettes in particular. Thus I cannot help but applaud your efforts, truly given at the last possible moment, to get the balance of information to at least appear more congruent with the body of research.
It is reminiscent of the scene in Animal House (Universal 1978) where Tim Matheson utters the immortal lines:
“We gotta take these bastards. Now we could do it with conventional weapons, but that could take years and cost millions of lives. No, I think we have to go all out. I think that this situation absolutely requires a really futile and stupid gesture be done on somebody’s part!”
And you, Carl, were just the man to do it. Bravo Sir! We may not have actionable input to the coming regulations, but at least they know we will not go quietly.

I’m with you Carl. The thing that made ACT*UP so successful was their “Silence=Death” motto. In our case might we speculate that “Lies=Death” would be appropriate.
Glad you caught my point, I feared it may have been a tad too obtuse for readers. Though I do think that you successfully managed to screw up a perfectly good parade of propaganda that was the bulk of the workshop hearings. :-)
Now about that recruitment study on Craig’s list…

I too watched the video. (I didn’t realise that were such a handsome chap)

It was refreshing to hear someone speak who was not ‘speaking in tongues’. I was a bit perplexed by what the lady who was talking about pregnant women was implying. It sounded to me as though she was implying that pregnant women should not breath any air which has not been filtered and purified.
Am I right about the guy who was talking about calls to the poison centre? Did he compare the number of such reports when almost no one was using ecigs with present day reports (1400% increase)?
It is worrying that there was so much slant towards the vague possibilities of harm.

The pregnancy people are pretty much like the public health people, acting like their concern trumps everything else. At least they have a defensible moral case (not necessarily right, mind you, but defensible): The public health people think that people should be forced to behave a particular way for their own good. But the fact that they have to be forced means that it is not for their own good. The pregnancy people thinking pregnant women should be forced to behave a certain way for the health of the fetus. While you can certainly disagree, at least there is a possible basis for that (if you value the interests of the fetus as trumping the interests of the mother).

Yes, that poison control calls game is almost a mantra now. An infinity percent increase over the last decade!!!! Everyone does it. And yes it is obviously stupid, but they get away with it because their target audience are stupid people.

Tobacco Harm Reduction (THR)

THR is the public health strategy of encouraging smokers to switch to low-risk alternatives like smokeless tobacco and e-cigarettes. It is the only proven method for reducing smoking below about a fifth of the population once it becomes established. (So why would anyone be anti-THR? See the "About" page.)

The continuing scourge of [smoking]-produced disease is unlikely to yield to today’s "evidence-based" interventions. (scare quotes added) Kenneth E Warner; see post if the implications are not obvious

If someone says the sky is green, you prove that it’s actually blue, and the next day he comes back once again insisting that the sky is green, and this happens repeatedly, you eventually have to acknowledge that mannerly debate about the color of the sky just isn’t enough; you have to go meta, and talk about the fact that this guy and his friends just aren’t in the business of honest discussion. Paul Krugman

He who is merciful to the cruel will become cruel to the merciful. Ancient Midrash